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Health systems characteristics and pharmaceutical coverage, 2010
Coverage for basic health needs
and for pharmaceutical care
Definition of the
pharmaceutical benefit package
Belgium
Almost all residents (99%) are covered by
Positive lists for outpatient and inpatient medsocial health insurance, which includes cover- icines.
age for pharmaceutical care.
Denmark
All residents are covered by the national
Positive list for outpatient medicines; Hospital
health system, which includes pharmaceutical formularies for medicines used in hospitals
coverage.
(exclusively or not).
France
All residents are covered by social health
insurance, which includes pharmaceutical
coverage.
Positive lists for outpatient and inpatient medicines.
Germany
All residents are covered either by social
health insurance (90% of the population) or by
private health insurance (10%). In both cases,
the basic benefit package includes pharmaceuticals.
All medicines marketed in Germany are covered by SHI, unless they belong to one of the
categories excluded from reimbursement by
Law or regulation. The law defines benefits
covered by statutory health insurance on a
general level and the Federal Joint Committee
defines concrete benefits. Private health insurers have some latitude to define benefits
covered but generally offer similar benefits.
Italy
All residents are covered by the national
Positive lists for outpatient and inpatient medhealth system, which includes pharmaceutical icines.
coverage.
Netherlands
All residents are covered by mandatory health Health insurers compete with potential differinsurance, which includes pharmaceutical
ences in benefits covered. However, they
coverage.
must provide coverage for medicines included
in a centrally defined positive list.
Spain
All residents are covered by the national
Positive lists for outpatient and inpatient medhealth system, which includes pharmaceutical icines.
coverage.
Sweden
All residents are covered by the national
Positive lists for outpatient and inpatient care.
health system, which includes pharmaceutical
coverage.
United Kingdom All residents are covered by national health
systems, managed by governments (England
and Wales, Scotland and Northern Ireland).
In England and Wales, all medicines are in
principle covered by default, unless they belong to a category excluded from NHS coverage and/or are included in a negative list.
Hospitals draw their own formularies.
Norway
All residents are covered by national health
insurance, which includes pharmaceutical
coverage.
Positive list for out-patient drugs.
Australia
All residents are covered by the national
Positive list (PBS schedule) for medicines
health system Medicare, which includes the
covered by the PBS. Public hospitals define
Pharmaceutical Benefits Scheme. The PBS
their own formularies.
covers drugs dispensed in community pharmacies or in private hospitals, as well as
some highly specialised drugs in public hospitals. States finance most medicines used in
public hospitals.
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Health systems characteristics and pharmaceutical coverage, 2010
Coverage for basic health needs
and for pharmaceutical care
Definition of the
pharmaceutical benefit package
Canada
All residents are covered by the national
health system Medicare. Medicare covers
pharmaceutical used in inpatient care, but not
pharmaceuticals used in outpatient care.
Pharmaceutical coverage for outpatient care
is obtained through private health insurance
for about 2/3 of residents, and by public drug
plans for the remaining 1/3. All residents over
65 years are covered by provincial plans, as
well as all residents in Manitoba and Saskatchewan once deductibles have been exceeded.
Drug formularies defined by each drug plan –
public or private- with specific rules
Japan
Almost all residents are covered by social
health insurance and the remaining (about
1%) by public assistance. Both include pharmaceutical coverage.
Positive list for outpatient and inpatient medicines.
Korea
All residents are covered, either by national
health insurance (97%) or by a tax-funded
program.
Positive list for outpatient medicines.
Source: Value in Pharmaceutical Pricing, OECD Health Working Papers No. 63, 2013, pp. 18-19.
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